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1 THE NEWCASTLE UPON TYNE HOSPITALS NHS FOUNDATION TRUST PUBLIC HEALTH UPDATE Agenda item A5(vi) EXECUTIVE SUMMARY This paper updates the Board in relation to the work ongoing in the Trust in fulfilment of its Public Health responsibilities. These responsibilities lie within three broad areas: Provision of directly commissioned public health services. Delivery of care targeted at improving the health and wellbeing of all patients Making Every Contact a Health Improving Contact. Influencing the health and wellbeing of employees. The key issues in each area are highlighted. There are forthcoming changes within the Trust s Stop Smoking Service and Health Improvement Team due to the changes in the commissioning arrangement of the service from April 2014 which take effect from 1 st August These changes will have a significant effect on the availability of Public Health expertise within the Trust and capacity to take work forward. Specific work was undertaken in relation to Alcohol Screening as part of 2014/2015 CQUIN which achieved full payment in excess of 1m and an update on this work is provided. The Public Health challenges within the population of Newcastle remain significant and as a major employer the Trust is committed to influencing the wellbeing of its workforce. This is in line with the corporate priority to reduce sickness absence. There is a strong wellbeing offer already available for staff this has been further developed through participating in the Better Heath at Work Award and progress and challenges are reported. RECOMMENDATION To i) receive the briefing ii) note commissioning changes and potential risks and iii) comment on future progress in relation to participation in the Better Health at Work Award. Mrs Helen Lamont Nursing and Patient Services Director Ms Frances Blackburn Head of Nursing, Freeman 14 th July 2015

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3 THE NEWCASTLE UPON TYNE HOSPITALS NHS FOUNDATION TRUST PUBLIC HEALTH UPDATE 1. INTRODUCTION The Trust has a number of Public Health responsibilities which lie within three broad areas: Provision of directly commissioned public health services. Delivery of care targeted at improving the health and wellbeing of all patients - Making Every Contact a Health Improving Contact. Influencing the health and wellbeing of employees. This paper updates the Board with regard to these responsibilities, and changes within the directly commissioned services, that the Trust delivers. The Trust contributes to tackling these through delivery of the National initiative Making Every Contact a Health Improving Contact, and a range of other initiatives including delivery of Stop Smoking Services, developments in delivery of alcohol screening, and influencing the wellbeing of its employees. Work to support training packages to increase staff confidence with this aspect of work is being developed to try and mitigate some of the impact of the expertise within the Health Improvement Team being lost to the Trust as a consequence of the changes in commissioning arrangements. The Board endorsed the Trust s participation in the Better Health at Work Award in December Work has progressed and there is now a network of volunteer Health Champions across the Trust, and a number of staff health and wellbeing campaigns have been delivered. The Trust is to be assessed against the Bronze Award Standards in October and whilst some progress has been made there is much more that could be achieved in this regard. Regrettably it has not been possible to identify any resources to take this work forward and this is limiting the pace of progress. 2. CHANGES TO DIRECTLY COMMISSIONED PUBLIC HEALTH SERVICES As the Board is aware responsibility for public health is now vested within Newcastle City Council and a major part of their role is to commission Public Health Services. There are currently a number of specialist Public Health Services within the Community Directorate and commissioning arrangements for some of these services are changing imminently. 1

4 i) Health Improvement Team based at New Croft House and Your Homes Newcastle. The work of the team includes: Delivery and monitoring of health improvement programmes. Current programmes include mental health, vulnerable young people, You re Welcome, men s health, Better Health at Work, alcohol, obesity, infant nutrition, tobacco control, healthy schools, housing and health. Developing health improvement strategies and policies with partner organisations; local authorities, NHS organisations, employers, voluntary and community bodies. Training, advice, consultancy and support on all aspects of health improvement to workers and organisations that can influence health. This service is moving to Newcastle City Council and will be based at Civic Centre as of 1st August This transfer will strengthen the City Council s capacity in relation to policy and strategy development but also means that access to expertise and advice in all these areas will no longer be directly available to the Trust. This poses potential risks in terms of being able to ensure appropriate advice and training is available to Trust Clinicians, and in relation to undertaking elements of work such as baseline assessments against NICE guidance and quality standards. ii) Stop Smoking Service based at New Croft House The team helps and advises people to quit smoking and offers training to healthcare teams to enable them to advise people who smoke about the risks particularly at times of increase risk eg during pregnancy. The service is being re-commissioned by Public Health; the Trust Executive has made the decision not to submit a tender to retain the contract due to the risks posed to service quality by the significant benefit reduction (original budget 500,000 reduced to 250,000), increased activity expectations and increased operational costs, thus carrying inherent high financial risk and potential reputational risk for the Trust. The Trust s Stop Smoking Service staff will, therefore, transfer to the successful contract bidder under TUPE. The contract is for 2 years with option to extend for a further 12 months, commencing 1st October The City Council non-clinical model is significantly different to the current model and could be perceived to lack the evidence base or established quality standards of the current service. The reliance will very much be on trained, but not qualified clinical staff. However, the Trust will not carry the financial and reputational risk associated with the Stop Smoking contract and delivery model. It is not clear if the service will provide access to training for Trust staff to equip them to deliver Brief or Intermediate advice, or access a specialist Stop Smoking Advisor for secondary care. This may reduce the provision of on-site stop smoking clinics which are currently available to patients. 2

5 iii) Health Improvement Service for Ethnic Minorities (HISEM) based at New Croft House This is a City wide service working with people from all Black and Minority Ethnic (BME) communities including asylum seekers, refugees, migrants and international students. The service mainly works with adults and families with children. HISEM supports: BME communities to access local health services such as GP s and dental care. Promotion of healthier lifestyle (stop smoking, healthy eating, physical activity). HISEM will remain with the Trust, under a newly agreed service level agreement ( ). The expected high level outcomes are to contribute to the achievement of national and local targets for BME communities on reducing inequalities, improved quality of life expectancy, mental and emotional well-being, reduced obesity, cancer, CHD, diabetes, sexual health issues, smoking, alcohol and substance misuse. iv) Future Risks The Department of Health is to consult on an in year cut of 200m to Council controlled public health budgets (revealed by George Osborne on ) The cut would affect spending this year and will be worth 7.4% of the 2.7bn annual budget devolved to Councils via Public Health England. The impact of this on NHS providers is the potential loss of emphasis on Ill health prevention and reduced health promotion activity. 3. MAKING EVERY CONTACT A HEALTH IMPROVING CONTACT There are many opportunities across the Trust to engage patients, clients and families in relation to health and wellbeing through opportunities to provide formal screening, information or brief advice, signpost and refer onto public health services. Delivery of Smoking Brief Advice is well embedded within the Trust. There is a strong evidence base for delivering alcohol screening and brief interventions (ASBI). The Trust committed though a CQUIN project to introduce Alcohol Screening and Brief Intervention into a number of care settings in the Trust including Sexual Health, ENT and Cardiothoracic pathways and delivery of brief advice in ED. The indicator was split into two parts: Part (a) to increase the recording of alcohol status in A&E, for all patients. Part (b) to increase the proportion of those patients who reported higher risk alcohol consumption (within the areas of A&E, ENT, Cardiothoracic and Sexual Health) that received a brief intervention or information leaflet. Work progressed well over the course of the year meeting all key milestones. The quarter 4 requirements of: 3

6 Increasing the recording of alcohol status in A&E, for all patients and to achieve a performance of 75%. Achieving a performance of 75% of patient records having an alcohol status recorded in ENT, Cardiothoracic and Sexual Health. Increasing the proportion of those patients reporting higher risk alcohol consumption (within the areas of A&E) that have received an information leaflet and achieve a performance of 80%. Achieving a performance of 80% of patients who were recorded with a higher risk of alcohol consumption as per Audit C (a validated alcohol consumption and risk measurement tool) having received a brief intervention in ENT, Cardiothoracic and Sexual Health. All were achieved and full payment has been made for this indicator, at a value of 1,249,050 to the Trust. Work has also progressed to develop E-Learning packages to help staff deliver core public health messages in relation to smoking, weight and alcohol. This work has been led by members of the Health Improvement team and it is hoped this will be completed before they leave the Trust. These training packages will not be mandatory for staff but will be recommended to all clinical staff as best practice. 4. EMPLOYEE HEALTH AND WELLBEING As a significant major employer the Trust has opportunities to influence the wellbeing of its significant workforce. In December 2013 the Trust Board endorsed participation in The North East Better Heath at Work Award. The Trust Better Health at Work initiative has made progress, achievements to date have been: 48 Health Champions have been recruited from across the Trust, these are voluntary roles. Health Champions will lead local initiatives, signpost colleagues to sources of support, advice and information and obtain feedback and suggestions from staff on health and wellbeing activities. Health Champions at Centre for Ageing and Vitality have run a weight watching group for any staff on that site which has helped staff lose weight. Completion of a Trust wide Health Needs Assessment Survey. Developed a range of additional Physical Activity options for staff for example two Couch to 5k runs have been initiated, one from RVI and one from Freeman on a weekly basis run by staff who having volunteered to lead these have been provided with run leader training both leave Trust sites at 5:30pm and are currently being promoted to staff. Staff facing awareness raising campaigns related to alcohol, cancer and smoking. 4

7 Provision of sleeping resource for staff, available on the Intranet and Benefits Everyone web pages. This was also circulated to managers of staff who traditionally work shift patterns. The Trust is due to be assessed against the Bronze standards in October Whilst progress has been made there are challenges related to the capacity to maintain momentum in taking initiatives forward, and responding to the analysis of the Health Needs Assessment. Attempts to identify resource which could significantly increase the profile of this work, as well as a number of campaigns and activities have been unsuccessful. There is therefore a degree of risk that the Trust will not be able to demonstrate the required progress, or to progress beyond Bronze level. 5. CONCLUSIONS The Trust is committed to delivery of its Public Health responsibilities and much work has been achieved and is planned to maximise its contribution. There have been changes within the directly commissioned services for 2014/15. These will take affect from August 2015 and do pose challenges and risk in terms of the Trust s capacity to fulfil its public health responsibilities. The Trust is committed to improving the wellbeing of its workforce. The wellbeing offer already available for staff has been enhanced through participation in The Better Heath at Work Award. However no resource to increase the pace and scale of this work has been secured and whilst progress towards assessment at the Bronze (entry) Level of this award should progress in October it is not certain that achievement at a higher level would be possible. 6. RECOMMENDATION To i) receive the briefing ii) note commissioning changes and potential risks and iii) comment on future progress in relation to participation in the Better Health at Work Award. Mrs Helen Lamont Nursing and Patient Services Director Ms Frances Blackburn Head of Nursing Freeman 14 th July

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